Vol.:(0123456789) 1 3 Journal of Thrombosis and Thrombolysis https://doi.org/10.1007/s11239-019-02031-4 Does telehealth improve anticoagulation management in patient service centers (PSC)? A pilot project Maria R. Bernstein 1  · Libiny John 2  · Susan Sciortino 2  · Elise Arambages 2  · Danielle Auletta 1  · Alex C. Spyropoulos 1,2,3,4 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Anticoagulation Management Services (AMS) are known to improve warfarin management in the outpatient setting. The guideline recommendations are well established and indicate that patients who receive a Vitamin K antagonist (VKA) should be under the care of an experienced and specialized anticoagulation clinic (Lip et al. in Chest 154(5):1121–1201, 2018). Warfarin, a VKA, is considered a high risk medication and one of the most common causes of adverse events with poor patient outcomes. Anticoagulation care is assessed by measuring the percent of Time in Therapeutic Range (TTR) in patients receiving a VKA. Evidence shows that a 10% improvement in TTR has been associated with a 10% reduction in adverse event rates. Optimal management over usual medical care should prevent 7 myocardial infarctions, strokes, major bleeds, or deaths per 100 patients/year (Bussey et al. in Pharmacotherapy 9(4):214–219, 1989). Telehealth or telemedicine can be defned as the use of electronic information along with telecommunication technologies to provide medical services to individuals that are in remote locations from each other (Perednia in JAMA 273(6):483–488, 1995; Gray et al in J Thromb Thrombolysis 2019(48):690–693, 2019). This technology allows a provider located at a distant site to use two-way audio visual electronic communication to deliver clinical health care services to a patient who is located at an originating site (Kristian et al. Int J Technol Assess Health Care 28(1):44–51, 2012; Testa and Zimmermann in Telemedicine for managing patients on oral anticoagulant, 2011; Telehealth Services in CMS Manual System Pub 100-04 medicare claims processing, 2019). The goals of the Telehealth Anticoagulation Management Service are to: (1) increase patient satisfaction (2) reduce turnaround time for results by providing the INR (International Normal Ratio) results in real time (3) increase patient compliance to INR testing and (4) improve system wide anticoagulation care by increasing cTTR (center Time in Therapeutic Range) metrics to high quality metrics of 65% and above. The overarching goal of our health system Telehealth program was to develop a collaborative care telemedicine INR model in collaboration with core laboratories (Patient Service Centers or PSCs) in order to improve patient quality metrics on warfarin. In this model, the Tele-ACTS Center (Telehealth Anticoagulation and Clinical Thrombosis Service) team was able to provide distant care for the outpatient population on warfarin maintenance therapy using a virtual telemedicine INR model located in a distant location to the PSC. Using this model, we were able to improve center-based TTR by 45.73%. Keywords Telehealth · Anticoagulation management service · Warfarin · Patient service center Highlights • Management of anticoagulation is known to be highly efective in AMS [1–3] with cTTR of > 70%. • Nurse practitioner-led warfarin management provides a benchmark for high quality TTR’s in PSC’s using Tel- ehealth technology over (UMC). • Integration of technologies in anticoagulation care using a distant telemedicine INR model may improve the care * Maria R. Bernstein mbernstein7@northwell.edu 1 Northwell Health At Lenox Hill Hospital, New York, NY, USA 2 Northwell Health At Staten Island University, Staten Island, NY, USA 3 Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Hempstead, NY, USA 4 Center for Health Innovations and Outcomes Research, The Feinstein Institute for Medical Research, Manhasset, NY, USA